The Importance of Image Quality in the Urological Workflow - Episode 2

Radiation Exposure From Imaging Assessments in Urology

April 23, 2021
Brad Schwartz, DO, FACS

,
Kristie Kahl

Brad Schwartz, DO, FACS, comments on radiation exposure associated with imaging assessments used in urology and explains what he and colleagues are doing to minimize exposure and address patient concerns.

Kristie Kahl: What is your imaging system of choice?

Brad Schwartz, DO, FACS: It sounds a little quaint, but I started my residency in 1990. I was in the Army. The military contracts at the time were with Liebel-Flarsheim Urology tables and cysto tables. Since 1990, virtually in every location where I have been and I have practiced, we have had a Liebel-Flarsheim cysto table. For 30 years, I have used their tables in every location I have ever worked. I do find them extremely reliable. Their service is very dependable. The quality of their image is good. They keep up with technology, and they try to push the edge of image quality while we are working intraoperatively. Their image quality is far superior to others on the market.

Kristie Kahl: How concerned are you with the radiation dose at your practice?

Brad Schwartz, DO, FACS: Very. There have been a number of articles that have addressed the need for minimal exposure and maximum protection during radiation imaging. Some studies indicate that it may not be as serious as we originally thought. However, the bottom line is that radiation safety within our environment is extremely important.

Kristie Kahl: In your experience, have you found that some imaging systems use less radiation?

Brad Schwartz, DO, FACS: I am not aware of what the differences in radiation exposure is with the different systems on the market. I know that all companies are moving toward trying to minimize exposure and risk. They can do that through a number of technological advances in the system itself. Also, through radiation education, we can reduce exposure. At our institution [Southern Illinois University School of Medicine], we have to take a yearly radiation safety course. That is a yearly, required training that is very good. It is very much needed, and it does result in decreased radiation exposure to the staff and the patients.

Kristie Kahl: How do you address patients’ concerns when it comes to radiation risk?

Brad Schwartz, DO, FACS: With our chronic stone formers, that is a real potential issue. They come to the ER [emergency department], and they get CT scans. They go to different ERs in different regions of the state. They might get more CT scans at different locations because they are unaware of where they were just were 5 days ago. I try to let them know, very carefully, that there is an inherent amount of radiation that everyone gets just by going outside or flying in an airplane—just from the environmental sources. The technology that we have has minimized the risk of exposure to the greatest extent possible. We have ultra-low dose CT scans that we can use. We use shielding for many patients during these scans. We try to use ultrasound and MRI when feasible to limit the radiation dose. In the operating room, we try to maintain our distance from the radiation source. We all wear lead aprons and lead thyroid shields. Most of the surgeons have lead glasses that we use. We all are required to do the radiation safety courses. We do as much as we can to limit the amount of radiation exposure to the patient; we do so by employing less radiation and being careful and sensible about their exposure.

Kristie Kahl: Right. Absolutely. How do you track radiation dose?

Brad Schwartz, DO, FACS: We are required by state regulation to wear dosimetry badges. We wear them based on the guidelines, and we turn those in monthly. We get reports back. So far, we have been responsible. We do a good job. We have never really been flagged for excessive radiation exposure. That is a fairly typical method of tracking radiation doses—through these badges required by the state.

Transcript edited for clarity.